Hsu Wei-Kuo, Liu Shu-Cheng, Chuang Hao-Chun, Wang Chi-Hsiu, Kuan Fa-Chuan, Hsu Kai-Lan, Su Wei-Ren, Hong Chih-Kai
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Anesthesia, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Orthop J Sports Med. 2024 Dec 21;12(12):23259671241303731. doi: 10.1177/23259671241303731. eCollection 2024 Dec.
The effects of the erector spinae plane (ESP) block and interscalene nerve block (ISNB) on arthroscopic rotator cuff repair (RCR) have been investigated separately.
To evaluate whether additional catheterization for the ESP block can decrease acute postoperative pain and opioid consumption above the ISNB and multimodal oral analgesics in patients after arthroscopic RCR.
Cohort study; Level of evidence, 3.
Included were patients who underwent primary arthroscopic RCR between January 1 and December 31, 2021, and received either ISNB (ISNB group) or additional ESP block catheterization (ESP block group) as part of their pain management. Patients who underwent concomitant shoulder procedures were excluded. Patient characteristics, surgical details, pre- and postoperative numerical pain rating scale (NPRS) scores, rescue analgesic use, and possible opioid-related side effects were recorded. The primary outcome was the NPRS score immediately after surgery; secondary outcomes included rescue opioid use and opioid-related side effects until patients were discharged the next day. The Mann-Whitney test or the chi-square test was used for between-group comparisons. Multiple linear regression analysis was conducted to examine predictors for total opioid consumption.
A total of 54 patients were included-21 in the ISNB group and 33 in the ESP block group. The ESP block group exhibited significantly lower postoperative NPRS scores (2 ± 0.3 vs 3 ± 1.6 for ISNB; = .003), reduced opioid consumption during hospitalization (0.5 ± 1.3 vs 6.1 ± 8.3 morphine milligram equivalent [MME] for ISNB; < .001), and fewer opioid-related side effects (0 vs 3 for ISNB; = .022). Multiple linear regression analysis indicated that the analgesic protocol (β = 5.750; < .001) and the number of anchors used (β = 1.609; = .022) were independently correlated with higher opioid consumption. Subgroup analysis revealed that additional ESP block significantly reduced opioid consumption during repairs involving ≥2 tendons (7.6 ± 9 vs 0.5 ± 1.4 MME; < .001).
The study findings indicated that additional catheterization for the ESP block reduced postoperative pain, opioid consumption, and opioid-related side effects during the acute postoperative period of arthroscopic RCR when the ISNB and multimodal oral analgesics had already been administered. Future studies are needed to evaluate this treatment protocol.
竖脊肌平面（ESP）阻滞和肌间沟神经阻滞（ISNB）对关节镜下肩袖修复术（RCR）的影响已分别进行了研究。
评估在关节镜下RCR术后患者中，ESP阻滞额外置管是否能比ISNB和多模式口服镇痛药更有效地减轻术后急性疼痛并减少阿片类药物的使用。
队列研究；证据等级，3级。
纳入2021年1月1日至12月31日期间接受初次关节镜下RCR且作为疼痛管理一部分接受ISNB（ISNB组）或额外ESP阻滞置管（ESP阻滞组）的患者。排除同时进行肩部其他手术的患者。记录患者特征、手术细节、术前和术后数字疼痛评分量表（NPRS）评分、补救镇痛药使用情况以及可能的阿片类药物相关副作用。主要结局是术后即刻的NPRS评分；次要结局包括直到次日患者出院时的补救阿片类药物使用情况和阿片类药物相关副作用。采用Mann-Whitney检验或卡方检验进行组间比较。进行多元线性回归分析以检查总阿片类药物消耗量的预测因素。
共纳入54例患者，ISNB组21例，ESP阻滞组33例。ESP阻滞组术后NPRS评分显著更低（ISNB组为3±1.6，ESP阻滞组为2±0.3；P = 0.003），住院期间阿片类药物消耗量减少（ISNB组为6.1±8.3吗啡毫克当量[MME]，ESP阻滞组为0.5±1.3；P < 0.001），且阿片类药物相关副作用更少（ISNB组为3例，ESP阻滞组为0例；P = 0.022）。多元线性回归分析表明，镇痛方案（β = -5.750；P < 0.001）和使用的锚钉数量（β = -1.609；P = 0.022）与更高的阿片类药物消耗量独立相关。亚组分析显示，在涉及≥2条肌腱的修复中，额外的ESP阻滞显著减少了阿片类药物消耗量（7.6±9与0.5±1.4 MME；P < 0. ... 01）。
研究结果表明，在已给予ISNB和多模式口服镇痛药的情况下，ESP阻滞额外置管可减轻关节镜下RCR术后急性期的疼痛、阿片类药物消耗量及阿片类药物相关副作用。未来需要进一步研究评估该治疗方案。
